Efficacy of RFA in Treating Dysplastic Barrettʼs Esophagus

Abstract

Purpose: Dysplastic Barrett's esophagus (BE) carries a small but significant risk of esophageal cancer. Radiofrequency ablation (RFA) has previously been shown to be effective in populations with a high incidence of esophageal cancer. We aimed to describe our center's experience with (RFA) for dysplastic BE. Methods: Patients with dysplastic BE and treated with RFA between 2006 and 2012 were included. All slides were reviewed by IU pathologists. Those previously treated for esophageal cancer, who had invasive or poorly-differentiated cancer at the time of referral, or were initially treated with PDT, APC, bipolar cautery, or cryotherapy were excluded. All nodularity was removed by EMR prior to starting RFA. In general, patients were treated with either circumferential or focal RFA every 8 weeks until eradication of BE. Surveillance biopsies and possible touch up with other ablation modalities then took place every 6-12 months. Results: Over the study period, 141 patients were treated and 93 met inclusion criteria. 66 patients (71%) required EMR prior to RFA. After excluding 18 pts lost to follow-up, 25 pts with low-grade dysplasia (LGD) and 49 pts with high-grade dysplasia (HGD) or intramucosal adenocarcinoma (IMC) were included in the analysis (87% male). The mean age at first RFA was 67.1 years (range 42-89). The mean length of the original Barrett's segment was 5.9cm (SD 3.51). A median of 1 treatment was required to eliminate dysplasia in pts with LGD; 2 sessions were required for pts with HGD. 65 patients(87%) achieved remission from dysplasia and were followed for at least two years; of these, 74.5% with LGD and 84.5% with HGD remained free of dysplasia. In 7 pts (7.5%), dysplasia progressed while on treatment (IMC found to have lymph node involvement in 2, HGD to IMC in 3, and LGD to HGD in 2). Conclusion: In our referral population, we eradicated dysplasia in 87% of patients, and that remission was maintained for at least 24 months in 74.5% of LGD pts and in 84.5% of HGD pts. Prospective studies in a similar population and of longer duration should be performed to further define the role of RFA. Disclosure: Dr. Rex receives speaker's bureau and research support from Olympus. No other authors have conflicts of interest.Figure: [60]